Cost Of US Research Articles

State and National Estimates of the Cost of Emergency Department Pediatric Readiness and Lives Saved

High emergency department (ED) pediatric readiness is associated with improved survival among children receiving emergency care, but state and national costs to reach high ED readiness and the resulting number of lives that may be saved are unknown. To estimate the state and national annual costs of raising all EDs to high pediatric readiness and the resulting number of pediatric lives that may be saved each year. This cohort study used data from EDs in 50 US states and the District of Columbia from 2012 through 2022. Eligible children were ages 0 to 17 years receiving emergency services in US EDs and requiring admission, transfer to another hospital for admission, or dying in the ED (collectively termed at-risk children). Data were analyzed from October 2023 to May 2024. EDs considered to have high readiness, with a weighted pediatric readiness score of 88 or above (range 0 to 100, with higher numbers representing higher readiness). Annual hospital expenditures to reach high ED readiness from current levels and the resulting number of pediatric lives that may be saved through universal high ED readiness. A total 842 of 4840 EDs (17.4%; range, 2.9% to 100% by state) had high pediatric readiness. The annual US cost for all EDs to reach high pediatric readiness from current levels was $207 335 302 (95% CI, $188 401 692-$226 268 912), ranging from $0 to $11.84 per child by state. Of the 7619 child deaths occurring annually after presentation, 2143 (28.1%; 95% CI, 678-3608) were preventable through universal high ED pediatric readiness, with population-adjusted state estimates ranging from 0 to 69 pediatric lives per year. In this cohort study, raising all EDs to high pediatric readiness was estimated to prevent more than one-quarter of deaths among children receiving emergency services, with modest financial investment. State and national policies that raise ED pediatric readiness may save thousands of children's lives each year.

The Health and Economic Benefits of United States Investments in Measles and Rubella Control and Elimination

Background: Prior to measles vaccine introduction in 1963, measles virus caused hundreds of thousands of annual reported cases, which led to substantial US morbidity, mortality, and costs. Similarly, congenital rubella syndrome (CRS) led to highly visible and tragic lifelong disability for thousands of Americans, before rubella vaccine introduction in 1969. The US certified national virus transmission elimination of indigenous measles in 2000 and rubella in 2004. Methods: Applying an existing integrated transmission and economic model, this analysis characterizes the net benefits of US investments in measles (1963–2030) and rubella (1969–2030) immunization assuming continued high routine immunization coverage. Due to importation risks, the US maintains two doses of both vaccines in its routine immunization schedule. Results: This analysis estimates total US costs of 8.1 billion (economics reported in 2023 US dollars) for measles immunization for 1963–2023 and 14.1 billion for rubella immunization for 1969–2023. The analysis estimates an additional approximately 1.2 billion for measles immunization and 1.5 billion for rubella immunization expected for 2024–2030. Historical and future US investments prevented an estimated approximately 237 million measles infections, 228,000 measles deaths, 193 million rubella infections, and 166,000 CRS cases. These investments imply net benefits (from avoided treatment costs minus immunization costs) of approximately 310 billion for measles and 430 billion for rubella and CRS, even without incorporating avoided productivity losses and intangible costs. Conclusions: US investments in measles and rubella immunization continue to provide enormous savings of human and financial costs and to prevent substantial mortality and morbidity.

Evaluating the techno-economic potential of large-scale green hydrogen production via solar, wind, and hybrid energy systems utilizing PEM and alkaline electrolyzers

The study evaluates the potential of solar, wind, and hybrid PV/WT renewable energy systems for green hydrogen production in four Iraqi cities. Through a comparative analysis of six distinct scenarios involving the deployment of 60 MWp solar panels, 30 MWp wind turbines, and 45 MWp hybrid PV/WT systems, the research aims to ascertain the most energy-efficient and cost-effective strategy for hydrogen generation. This evaluation is aligned with the operational capacities of two types of water electrolyzers: Alkaline (AWE) and proton exchange membrane (PEM), each with a 17.5 MWp capacity. Employing the HOMER Pro software for system simulation and optimization, and considering a project timeline from 2022 to 2042, the study identifies Anbar City as the prime location for green hydrogen production, highlighting solar PV panels as the most economical option with the lowest levelized cost of energy at US $4.5/MWh. The analysis further demonstrates that hydrogen production costs are US $1.98/kg for AWE electrolyzers and US $2.72/kg for PEM electrolyzers, with net present costs of US $26.31 million and US $35.91 million, respectively. Moreover, the annual hydrogen output is estimated at 1.11 million kg for AWE and 1.19 million kg for PEM electrolyzers. These insights significantly contribute to the strategic planning and development of Iraqi green hydrogen sector, offering a valuable framework for policymakers and stakeholders invested in sustainable energy transitions.

Real-world treatment patterns, health care resource utilization, and costs in a US Medicare population with bronchiectasis.

Bronchiectasis carries a significant economic burden with high health care expenditures associated with frequent hospitalizations, physician visits, and treatments, including oral and intravenous antibiotics for repeated lung infections, airway-clearance therapy, and oxygen administration. Bronchiectasis exacerbations can contribute to this burden. To estimate US health care resource utilization (HCRU) and costs associated with bronchiectasis and with bronchiectasis exacerbations. This retrospective study used the 100% Medicare Fee-for-Service database (January 2014 to December 2020) to compare HCRU and costs among patients with bronchiectasis with those of patients without bronchiectasis (controls). For patients with bronchiectasis, the index date was a randomly selected bronchiectasis claim after more than 1 year of disease history and, for controls, a claim closest to their matched bronchiectasis patient's index date. All patients had continuous enrollment for at least 12 months pre-index (baseline) and at least 12 months post-index. Primary outcomes were all-cause, respiratory-related, and bronchiectasis-related HCRU and health care costs, which were presented by the overall sample and by segmented patient cohorts based on the number of exacerbations during baseline (0, 1, or ≥2). 92,529 patients with bronchiectasis (mean [SD] age, 76.7 [8.8] years; 72.3% female) and 92,529 matched controls qualified for the study. Compared with controls, patients with bronchiectasis presented greater mean (SD) all-cause physician visits (15.4 [10.0] vs 13.2 [9.7]; P < 0.001) and respiratory-related physician visits (5.2 [4.3] vs 1.9 [3.1]), pulmonologist visits (1.9 [2.2] vs 0.3 [1.0]), hospitalizations (0.4 [0.9] vs 0.3 [0.8]), emergency department visits (0.33 [1.0] vs 0.26 [1.0]), and total health care costs ($10,224 [$23,263] vs $6,704 [$19,593]). Respiratory-related HCRU was also greater in patients with more baseline exacerbations, with total health care costs of $8,506, $10,365, and $14,790 for patients with 0, 1, and at least 2 exacerbations, respectively (P < 0.01). This real-world study demonstrates the high disease burden associated with bronchiectasis and with exacerbations, highlighting the need to improve management and reduce exacerbations.

Cost-effectiveness of adjuvant icotinib versus chemotherapy for patients with stage II–IIIA EGFR-mutated non-small cell lung cancer in China

ObjectiveIcotinib has been approved for adjuvant treatment of stage II–IIIA non-small cell lung cancer (NSCLC) patients with activating epidermal growth factor receptor (EGFR) mutations in China, yet the long-term costs...

Machine learning in preclinical drug discovery.

Drug-discovery and drug-development endeavors are laborious, costly and time consuming. These programs can take upward of 12 years and cost US $2.5 billion, with a failure rate of more than 90%. Machine learning (ML) presents an opportunity to improve the drug-discovery process. Indeed, with the growing abundance of public and private large-scale biological and chemical datasets, ML techniques are becoming well positioned as useful tools that can augment the traditional drug-development process. In this Perspective, we discuss the integration of algorithmic methods throughout the preclinical phases of drug discovery. Specifically, we highlight an array of ML-based efforts, across diverse disease areas, to accelerate initial hit discovery, mechanism-of-action (MOA) elucidation and chemical property optimization. With advances in the application of ML across diverse therapeutic areas, we posit that fully ML-integrated drug-discovery pipelines will define the future of drug-development programs.

The Impact of Incentives on Data Collection for Online Surveys: Social Media Recruitment Study.

The use of targeted advertisements on social media platforms (eg, Facebook and Instagram) has become increasingly popular for recruiting participants for online survey research. Many of these surveys offer monetary incentives for survey completion in the form of gift cards; however, little is known about whether the incentive amount impacts the cost, speed, and quality of data collection. This experiment addresses this gap in the literature by examining how different incentives in paid advertising campaigns on Instagram for completing a 10-minute online survey influence the response rate, recruitment advertising cost, data quality, and length of data collection. This experiment tested three incentive conditions using three Instagram campaigns that were each allocated a US $1400 budget to spend over a maximum of 4 days; ads targeted users aged 15-24 years in three nonadjacent designated market areas of similar size to avoid overlapping audiences. Four ad creatives were designed for each campaign; all ads featured the same images and text, but the incentive amount varied: no incentive, US $5 gift card, and US $15 gift card. All ads had a clickable link that directed users to an eligibility screener and a 10-minute online survey, if eligible. Each campaign ran for either the full allotted time (4 days) or until there were 150 total survey completes, prior to data quality checks for fraud. The US $15 incentive condition resulted in the quickest and cheapest data collection, requiring 17 hours and ad spending of US $338.64 to achieve 142 survey completes. The US $5 condition took more than twice as long (39 hours) and cost US $864.33 in ad spending to achieve 148 survey completes. The no-incentive condition ran for 60 hours, spending nearly the full budget (US $1398.23), and achieved only 24 survey completes. The US $15 and US $5 incentive conditions had similar levels of fraudulent respondents, whereas the no-incentive condition had no fraudulent respondents. The completion rate for the US $15 and US $5 incentive conditions were 93.4% (155/166) and 89.8% (149/166), respectively, while the completion rate for the no-incentive condition was 43.6% (24/55). Overall, we found that a higher incentive resulted in quicker data collection, less money spent on ads, and higher response rates, despite some fraudulent cases that had to be dropped from the sample. However, when considering the total incentive amounts in addition to the ad spending, a US $5 incentive appeared to be the most cost-effective data collection option. Other costs associated with running a campaign for a longer period should also be considered. A longer experiment is warranted to determine whether fraud varies over time across conditions.

Understanding trends of US breast cancer hospitalization, mortality and costs using the National Inpatient Sample database.

11162 Background: Studies have shown a rising breast cancer incidence in the US. However, its impact on healthcare utilization is unclear. Our study delves into the previously unexplored territory of hospitalization and cost trends among breast cancer patients, aiming to shed light on resource allocation and potential areas for improvement. Methods: To investigate trends in breast cancer admissions and costs, we queried the National Inpatient Sample database. Patients admitted between January 2011 and December 2019 with following criteria were included in the analysis: female gender, age ≥ 18, and ICD diagnosis code corresponding to unspecified malignant neoplasm of the breast as their primary reason for admission. Our primary outcome was defined as the temporal trends in the number of admissions, discharge rates, length of stay, and cost of hospitalization and mortality rates. Analyses were performed using Stata version 15.1 College station TX: StataCorp LP 2017. Appropriate discharge weights were applied to the dataset during the analyses to account for critical elements of sampling design. A p-value of &lt;0.05 was considered statistically significant. Results: Between 2011 and 2019, hospital admissions for breast cancer as the primary diagnosis declined significantly, from 32,126 to 12,742 (P &lt; 0.001). However, while average length of stay increased slightly from 4.3 to 4.9 days (P &lt; 0.01), hospital charges for breast cancer rose dramatically. Adjusted for inflation, mean charges per patient rose 38.8%, from $50,663.86 in 2011 to $70,334.11 in 2019 (P &lt; 0.001). Despite this surge, the total aggregate cost ("national burden") of hospitalizations with breast cancer as main discharge diagnosis decreased, falling from $1.63 billion in 2011 to $896 million in 2019 (inflation adjusted) (P &lt; 0.001). Discharges for breast cancer peaked in women between 45 and 64, followed by the 65-84 demographic. Compared to the overall decrease in hospitalization rates, the declines in the above age groups were notably steeper with declines of 62% for 45-64 and 48% for 65-84 (p&lt;0.001). Although absolute number of breast cancer deaths decreased from 2011 to 2019, the mortality rate paradoxically increased from 4.3% to 5.8% over the same period (P &lt; 0.001). This seemingly contradictory trend warrants further investigation to better understand contributing factors. Conclusions: While breast cancer diagnoses are on the rise in women, our study reveals a fascinating paradox: significant declines in hospitalization, associated costs, and overall mortality. This encouraging trend likely stems from widespread surveillance mammography with increases in early stage, curable disease diagnosis, and the flourishing landscape of outpatient therapies, including targeted treatments, with more tolerable toxicity profiles allowing for majority of breast cancer care to be completed in the outpatient setting.

Conservation education initiatives for elementary school students at La Suerte Biological Research Station, Costa Rica.

Maderas Rainforest Conservancy (MRC) is a conservation non-profit organization that protects forests, offers primate field schools, and leads community outreach initiatives at sites in Central America, including La Suerte Biological Research Station (LSBRS) in Costa Rica. In 2018, MRC started Aula Verde, a conservation education initiative for elementary school students aged 5-12 at LSBRS. Groups of children from elementary schools and communities located within 50km have visited LSBRS from 2018-2023 to participate in the 1.5-2 hour Aula Verde workshop, which consists of (1) an interactive lecture on conservation, (2) a guided forest walk, and (3) a snack, gift bag, and tree seedling for each participant. Workshops are funded by international donations to MRC and cost US $8-16 per student. Aula Verde has been successful, with multiple schools and communities making repeat visits, students' families beginning to recycle their garbage and joining a WhatsApp group about conservation education that MRC staff initiated and lead, and teachers reporting improved learning outcomes for students who participate in the workshops. The success of Aula Verde is largely due to the ecological expertise and strong community ties of LSBRS staff. While the COVID-19 pandemic decreased Aula Verde offerings from 2020-2023, we expect workshops to resume at full capacity in 2024. In the future, MRC hopes to expand Aula Verde's outreach to all children aged 5-12 living within 50km of LSBRS.

Uncovering Current and Future Variations of Irrigation Water Use Across China Using Machine Learning

AbstractAccurately characterizing changes in irrigation water use (IWU) is crucial for formulating optimal water resource allocation policies, particularly in the context of climate change. However, existing IWU estimation methods suffer from uncertainties due to limited data availability and model constraints, restricting their applicability on a national scale and under future climate change scenarios. We present a robust framework leveraging machine learning and multiple data sets to estimate IWU across China. Forced with an ensemble of climate and socio‐economic projections, we appraise future trends and additional costs of IWU. Our model shows high accuracy in reproducing IWU, with coefficient of determination (R2) ranging from 0.86 to 0.91 and root mean square error from 0.261 to 0.361 km3/yr when compared to reported values in Chinese prefectures. Independent validation at 11 cropland sites further confirms the model's predictive power (R2 = 0.67). Under different emissions scenarios, China's IWU is projected to increase by 8.5%–17.1% (6.8%–34.8%) by 2050s (2100s) compared to the historical period (1981–2010), with higher emissions leading to more significant increases. This rise in IWU by 2050s (2100s) comes with an estimated additional cost of US $1.65–3.91 ($2.28–6.5) billion/year, highlighting the urgency for sustainable water management. Our study provides an effective approach for estimating current and future IWU using machine learning techniques, transferable to other countries facing increasing irrigation demands.

Degradation of Procion brilliant yellow H-E6G using ultrasonic and hydrodynamic cavitation combined with oxidants with demonstration at pilot scale.

The current study focuses on the degradation of Procion brilliant yellow H-E6G, an azo dye, using ultrasonic and hydrodynamic cavitation (HC), evaluating the impact of various parameters on the extent of degradation. The use of only ultrasound showed less oxidation capacity as indicated by only 19.1% degradation at an optimized power of 140 W, pH of 2.5, temperature of 40°C, and initial dye concentration of 15 ppm. The effectiveness of hybrid approaches involving US + H2 O2 , US + Fenton, and US + H2 O2 + potassium persulfate (KPS) was subsequently evaluated under optimized conditions. A notable enhancement in decolorization extent was observed for combined operations, including US + H2 O2 , US + Fenton, and US + H2 O2 + KPS (dual oxidant scheme) with the actual decolorization extents as 80.6%, 85%, and 92.2% respectively. An optimized scheme of US + H2 O2 + KPS was also utilized to decolorize the dye at a pilot scale using a US flow cell and also an HC reactor that yielded 91.8% and 88% reductions in initial concentration. The dye decolorization was elucidated to follow first-order kinetics for all the individual and combination approaches. The obtained values of the rate constants were also utilized for the evaluation of the synergistic index. A toxicity analysis was also performed on the dye, both before and following treatment, utilizing two bacterial strains. A comparative analysis of various treatment approaches has been presented focusing on factors such as cavitational yield, operational expenses, and energy requirements. The study elucidated that the combination of US + H2 O2 + KPS effectively removes Procion brilliant yellow H-E6G giving 92.2% as the maximum degradation at an operating cost of 0.1862 $/L. PRACTITIONER POINTS: First depiction of cavitative degradation of Procion brilliant yellow H-E6G Optimizing the equipment operating parameters and chemical oxidants Demonstration of optimized treatment scheme at pilot scale Evaluation of various approaches based on synergy and costs of treatment US + H2 O2 + KPS is the best approach for dye degradation.

Behavioral Insights from Vaccine Adoption in Nigeria: Cross-Sectional Survey Findings.

To generate behavioral insights for the development of effective vaccination interventions, we need approaches that combine rapid and inexpensive survey data collection with instruments based on easy-to-use behavior models. This study demonstrates how an inexpensive digital survey helped identify the drivers of COVID-19 vaccination in Nigeria. This study aims to illustrate how behavioral insights can be generated through inexpensive digital surveys. We designed and conducted a cross-sectional survey with multistage sampling. Data were collected from Nigerians (aged ≥18 years) from 120 strata based on age, sex, state, and urban or rural location. Respondents were recruited via advertisements on Meta platforms (Facebook and Instagram) using the Virtual Lab open-source tool. We used a Meta Messenger chatbot for data collection; participants were compensated with 400 naira (US $0.87 cents). Data collection took 2 weeks. In total, 957 respondents completed the survey, at an advertising cost of US $1.55 per respondent. An 18-item instrument measuring core motivators, ability barriers, sociodemographic characteristics, and respondents' vaccination status was pretested before data collection. We ran separate logistic regression models to examine the relationships between vaccine uptake and core motivators, ability barriers, and sociodemographic variables. A final model that predicted vaccine uptake included all 3 sets of variables. About 56% (n=540) of respondents reported that they had received at least 1 COVID-19 vaccination. Three core motivators were positively associated with vaccine uptake: the belief that the COVID-19 vaccine promised a better life (adjusted odds ratio [aOR] 3.51, 95% CI 2.23-5.52), the belief that the vaccine would allow respondents to do more things they enjoyed (aOR 1.97, 95% CI 1.33-2.93), and respondents' perception that their friends and family members accepted their decision to get vaccinated (aOR 1.62, 95% CI 1.06-2.48). Two ability barriers were negatively associated with vaccine uptake: cost- or income-related concerns lowered the odds of being vaccinated (aOR 0.35, 95% CI 0.24-0.50) and the lack of availability of vaccines at places respondents routinely visited also lowered their odds of being vaccinated (aOR 0.29, 95% CI 0.21-0.40). After adjusting for other variables, the perceived fear of getting COVID-19 and the hardship associated with the disease were no longer associated with vaccine uptake. These findings suggest that hope is more important for Nigerians than fear when it comes to vaccine adoption, enjoying life is more important than worrying about getting the disease, and approval from friends and family is more powerful than their disapproval. These findings suggest that emphasizing the benefits of leading a fuller life after being vaccinated is more likely to succeed than increasing Nigerians' fear of COVID-19. This study identifies a very different set of factors associated with COVID-19 vaccine adoption than previous Nigerian studies.

Use of Efficiency Frontiers to Align Prices and Clinical Benefits of Biologic Therapies for Plaque Psoriasis

The US lacks a systematic approach for aligning drug prices with clinical benefit, and traditional cost-effectiveness analysis (CEA) faces political obstacles. The efficiency frontier (EF) method offers policymakers an alternative approach. To assess how the EF approach could align prices and clinical benefits of biologic medications for plaque psoriasis and estimate price reductions in the US vs 4 peer countries: Australia, Canada, France, and Germany. This health economic evaluation used the EF approach to compare the prices and clinical benefits of 11 biologics and 2 biosimilars for plaque psoriasis in the US, Australia, Canada, France, and Germany. Data were collected from February to March 2023 and analyzed from March to June 2023. EFs were constructed based on each biologic's efficacy, measured using the Psoriasis Area and Severity Index (PASI) 90 response rate, and annual treatment cost as of January 2023; US costs were net of estimated manufacturer rebates. Prices based on the EF were compared with traditional CEA-based prices calculated by the Institute for Clinical and Economic Review at a threshold of $150 000 per quality-adjusted life-year gained. Among 13 biologics, PASI 90 response rates ranged from 17.9% (etanercept) to 71.6% (risankizumab); US net annual treatment costs ranged from $1664 (infliximab-dyyb) to $79 277 (risankizumab). The median (IQR) net annual treatment cost was higher in the US ($34 965 [$20 493-$48 942]) than prerebate costs in Australia ($9179 [$6691-$12 688]), Canada ($15 556 [$13 017-$16 112]), France ($9478 [$6637-$11 678]), and Germany ($13 829 [$13 231-$15 837]). The US EF included infliximab-dyyb (PASI 90: 57.4%; annual cost: $1664), ixekizumab (PASI 90: 70.8%; annual cost: $33 004), and risankizumab (PASI 90: 71.6%; annual cost: $79 277). US prices for psoriasis biologics would need to be reduced by a median (IQR) of 71% (31%-95%) to align with those estimated using the EF; the same approach would yield smaller price reductions in Canada (41% [6%-57%]), Australia (36% [0%-65%]), France (19% [0%-67%]), and Germany (11% [8%-26%]). Except for risankizumab, the EF-based prices were lower than the prices based on traditional CEA. This economic evaluation showed that for plaque psoriasis biologics, using an EF approach to negotiate prices could lead to substantial price reductions and better align prices with clinical benefits. US policymakers might consider using EFs to achieve prices commensurate with comparative clinical benefits, particularly for drug classes with multiple therapeutic alternatives for which differences can be adequately summarized by a single outcome measurement.

Cost-effectiveness of axicabtagene ciloleucel versus tisagenlecleucel for the treatment of 3L + relapsed/refractory large B-cell lymphoma in the United States: incorporating longer survival results

Aims To provide an update on the cost-effectiveness of the chimeric antigen receptor (CAR) T-cell therapies axicabtagene ciloleucel (axi-cel) and tisagenlecleucel (tisa-cel) for the treatment of relapsed/refractory (r/r) large B-cell lymphoma (LBCL) among patients who have previously received ≥2 lines of systemic therapy using more mature clinical trial data cuts (60 months for axi-cel overall survival [OS] and 45 months for tisa-cel OS and progression-free survival [PFS]). Methods A partitioned survival model consisting of three health states (pre-progression, post-progression and death) was used to estimate quality-adjusted life years (QALYs) and costs associated with axi-cel and tisa-cel over a lifetime horizon. PFS and OS inputs for axi-cel and tisa-cel were based on a previously published matching-adjusted indirect treatment comparison (MAIC). Long-term OS and PFS were extrapolated using parametric survival mixture cure models (PS-MCMs). Costs of CAR-T cell therapy drug acquisition and administration, conditioning chemotherapy, apheresis, CAR T-specific monitoring, stem cell transplant, hospitalization, adverse events, routine care, and terminal care were sourced from US cost databases. Health state utilities were derived from previous publications. Model inputs were varied using a range of sensitivity and scenario analyses. Results Compared with tisa-cel, axi-cel resulted in 2.51 additional QALYs and $50,185 additional costs (an incremental cost-effectiveness ratio [ICER] of $19,994 per QALY gained). In probabilistic sensitivity analysis (PSA), the ICER for axi-cel versus tisa-cel was ≤$50,000/QALY in 99.4% of simulations and ≤$33,500 in 99% of simulations. Axi-cel remained cost-effective versus tisa-cel (assuming a willingness-to-pay threshold of $150,000 per QALY) across a range of scenarios. Conclusions With longer-term survival data, axi-cel continues to represent a cost-effective option versus tisa-cel for treatment of r/r LBCL among patients who have previously received ≥2 lines of systemic therapy, from a US payer perspective.

Project Schedule Delays and Associated Circular Impacts of Socio-Economic and Environmental Issues that can Affect Sustainability Footprint of Mega-Projects.

The Padma Multipurpose Bridge and the Dhaka Metro Rail mega-projects in Bangladesh have significantly influenced regional identity and culture. Both projects, with costs of US 2.8 billion respectively, experienced substantial schedule delays of up to 9 years. This study examines the socio-economic and environmental impacts of these delays, focusing on the circular effects they create. Circular effects refer to reinforcing feedback loops between socio-economic factors (such as employment, income, and displacement) and environmental factors (such as land use and resource depletion) that exacerbate delays and hinder sustainable development. A qualitative approach was employed, using a multiple case study design to ensure depth and context. Data were collected through semi-structured interviews with 20 engineers and 40 beneficiaries, selected via purposive sampling to represent diverse stakeholder perspectives. In addition, sentiment analysis was conducted on media reports to capture public perception of the project delays. The data were analyzed using thematic analysis, allowing for the identification of recurrent patterns, including the socio-economic and environmental impacts contributing to the delays. The analysis revealed seven key factors contributing to delays: inadequate project planning, frequent design changes, miscommunication among stakeholders, and lack of contractor engagement, among others. Each of these factors created a ripple effect, wherein socio-economic disruptions (such as job losses and reduced income) exacerbated environmental impacts (such as extended land use and resource depletion). This cycle, in turn, led to further project delays. Addressing these circular effects is essential for breaking the chain of delays and their compounding impacts on sustainability. Based on the findings, the study recommends the adoption of advanced technologies, the use of sustainable materials, and the implementation of robust project monitoring systems. These recommendations are grounded in the evidence collected, which showed that addressing the root causes of delays could significantly reduce both the socio-economic damage and the environmental footprint of mega-projects. By implementing these solutions, future projects can achieve more efficient timelines and promote sustainable development.

Economic Burden of Mosquito-Borne Diseases in Low- and Middle-Income Countries: Protocol for a Systematic Review.

Globally, among all the vector-borne diseases, mosquito-borne diseases are responsible for a substantial number of cases and deaths and amount to an economic cost of US $12 billion per year. However, there is a dearth of systematic research conducted on the economic burden of mosquito-borne diseases. To address the lack of comprehensive information on this topic, a systematic review will be conducted to synthesize evidence for informing targeted policies and strategies addressing this growing burden and for better financial protection of households. The systematic review aims to review the economic burden of mosquito-borne diseases in low- and middle-income countries (LMICs). The review estimates the total cost, which is the compilation of both the direct costs and indirect costs. Additionally, it reports cost estimates per disease, country, and patient. The review outcome will also discuss the impact of the economic burden in terms of out-of-pocket expenditure, catastrophic health expenditure, impoverishment, and gross domestic product impact due to mosquito-borne diseases in LMICs. Systematic searches will be conducted in PubMed (MEDLINE), Ovid Embase, Scopus, the cumulative index of nursing and allied health literacy, and Cochrane CENTRAL. Additionally, websites of the World Bank, World Health Organization, and Asian Development Bank as well as grey literature (eg, Malaria No More and the Ministry of Health websites) will be searched to gather comprehensive information on the topic and identify studies published in the English language. The titles and abstracts will be independently screened by 2 reviewers, followed by a full-text review against the inclusion criteria. Disagreements will be resolved through discussion with a third author. The methodological reporting quality of the studies will be evaluated using the Larg and Moss checklist, Cochrane risk-of-bias tool for randomized trials, and the Consensus on Health Economic Criteria. Data will be extracted using a standardized data extraction form. The protocol was registered in PROSPERO (CRD42023427111) prior to the initiation of the search strategy. The review is currently ongoing and will synthesize information from the identified studies through a process involving structured screening, data extraction, and critical appraisal in the form of tables and a narrative summary of studies reporting the economic burden incurred due to mosquito-borne diseases in LMICs. This review seeks to report the economic burden of mosquito-borne diseases. It will act as evidence for policymakers to prioritize their decisions regarding containing the prevalence of mosquito-borne diseases and the means to lowering the incidence of diseases spread by mosquitoes. PROSPERO CRD42023427111; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=427111. PRR1-10.2196/50985.

Cost-Effectiveness of Caplacizumab in the Warranty Program in Immune Thrombotic Thrombocytopenic Purpura in the USA

Background Immune thrombotic thrombocytopenic purpura (iTTP) is a rare, life-threatening thrombotic microangiopathy. Caplacizumab is a humanized nanobody that inhibits formation of microthrombi in iTTP by disrupting binding of von Willebrand factor to platelets. It is the only treatment approved in combination with plasma exchange therapy (PEX) and immunosuppression (IS) for the treatment of iTTP. The United Kingdom National Institute for Health and Care Excellence (NICE) committee reviewed cost-effectiveness of caplacizumab. The committee concluded that addition of caplacizumab to PEX+IS is cost-effective and recommended that the drug be reimbursed in the UK. The Sanofi Promise Warranty Program ® (SPWP) was introduced in January 2023 in the US. It refunds the full cost of caplacizumab to the hospital when treatment is discontinued due to non-response defined as refractoriness (patient with platelet counts &amp;lt;50 × 10 9/L after 4 days of combined treatment with caplacizumab and PEX+IS; up to 6 doses are refunded), or exacerbation (new drop in platelet count after initial platelet count normalization [&amp;gt;150 × 10 9/L], necessitating re-initiation of PEX after ruling out any causes for the drop in platelet count other than iTTP pathophysiology, up to 12 pre-exacerbation doses are refunded). Objectives To evaluate the cost-effectiveness of adding caplacizumab to PEX+IS from a US perspective within the context of SPWP. Methods The NICE model was adapted to the US setting by replacing UK costs with US costs and discount rates. All clinical assumptions and structure remain unchanged. Clinical inputs were derived from the HERCULES trial (NCT02553317) intent-to-treat population (mean age: 46 years; females: 69%, exacerbation rates: 4.17% during double blind phase and 12.50% in total; refractoriness: 0%). The model consisted of a 3-month decision tree, which captured patient treatment and outcomes over the acute iTTP episode, followed by a long-term Markov model (time horizon: up to 55 years; 3-monthly cycles; Figure 1). An annual discount rate of 3% was applied for both costs and quality-adjusted life-years (QALYs). Under the SPWP, the cost of caplacizumab was assumed to be $0 for refractory patients and those who exacerbate early, no discount was applied for patients who experience exacerbations after drug discontinuation, however, clinical outcomes were captured. Results Prior to the SPWP, caplacizumab addition to PEX+IS delivered a gain of 1.75 QALYs (2.96 life-years [LYs]) as compared with PEX+IS alone, at an increased lifetime cost of $256,000. The incremental cost effectiveness ratio (ICER) was $146,350 per QALY and $86,420 per LY gained ( Table 1). An estimated 4.17% of treated patients qualified for the SPWP. With this outcomes-based program, the ICER improved to $138,480 per QALY and $81,780 per LY gained, respectively ( Table 1). Conclusion Based on these analyses using the UK NICE model adapted with US costs, caplacizumab is cost-effective considering WTP threshold of $150,000 to $200,000 and has improved cost-effectiveness when the warranty program is taken into account. Outcomes based programs can improve the cost effectiveness of a treatment in addition to mitigating concerns of perceived uncertainty of efficacy in treating patients with iTTP in the US.

Digitally Enabled Peer Support Intervention to Address Loneliness and Mental Health: Prospective Cohort Analysis.

Social isolation and loneliness affect 61% of US adults and are associated with significant increases in excessive mental and physical morbidity and mortality. Annual health care spending is US $1643 higher for socially isolated individuals than for those not socially isolated. We prospectively evaluated the effects of participation with a digitally enabled peer support intervention on loneliness, depression, anxiety, and health-related quality of life among adults with loneliness. Adults aged 18 years and older living in Colorado were recruited to participate in a peer support program via social media campaigns. The intervention included peer support, group coaching, the ability to become a peer helper, and referral to other behavioral health resources. Participants were asked to complete surveys at baseline, 30, 60, and 90 days, which included questions from the validated University of California, Los Angeles Loneliness Scale, Patient Health Questionnaire 2-Item Scale, General Anxiety Disorder 7-Item Scale, and a 2-item measure assessing unhealthy days due to physical condition and mental condition. A growth curve modeling procedure using multilevel regression analyses was conducted to test for linear changes in the outcome variables from baseline to the end of the intervention. In total, 815 ethnically and socially diverse participants completed registration (mean age 38, SD 12.7; range 18-70 years; female: n=310, 38%; White: n=438, 53.7%; Hispanic: n=133, 16.3%; Black: n=51, 6.3%; n=263, 56.1% had a high social vulnerability score). Participants most commonly joined the following peer communities: loneliness (n=220, 27%), building self-esteem (n=187, 23%), coping with depression (n=179, 22%), and anxiety (n=114, 14%). Program engagement was high, with 90% (n=733) engaged with the platform at 60 days and 86% (n=701) at 90 days. There was a statistically (P<.001 for all outcomes) and clinically significant improvement in all clinical outcomes of interest: a 14.6% (mean 6.47) decrease in loneliness at 90 days; a 50.1% (mean 1.89) decline in depression symptoms at 90 days; a 29% (mean 1.42) reduction in anxiety symptoms at 90 days; and a 13% (mean 21.35) improvement in health-related quality of life at 90 days. Based on changes in health-related quality of life, we estimated a reduction in annual medical costs of US $615 per participant. The program was successful in referring participants to behavioral health educational resources, with 27% (n=217) of participants accessing a resource about how to best support those experiencing psychological distress and 15% (n=45) of women accessing a program about the risks of excessive alcohol use. Our results suggest that a digitally enabled peer support program can be effective in addressing loneliness, depression, anxiety, and health-related quality of life among a diverse population of adults with loneliness. Moreover, it holds promise as a tool for identifying and referring members to relevant behavioral health resources.

Trade Liberalization and Chinese Students in U.S. Higher Education

Abstract We highlight a lesser-known consequence of China's integration into the world economy: the rise of services trade. We demonstrate how the US's trade deficit in goods cycles back as a surplus in US exports of education services. Focusing on China's accession to the World Trade Organization, we show that Chinese cities more exposed to trade liberalization sent more students to US universities. Growth in housing income/wealth allowed Chinese families to afford US tuition, and more students financed their studies using personal funds. Our estimates suggest that recent trade wars could cost US universities around $1.1 bn in annual tuition revenue.

Developing prompts from large language model for extracting clinical information from pathology and ultrasound reports in breast cancer.

We aimed to evaluate the time and cost of developing prompts using large language model (LLM), tailored to extract clinical factors in breast cancer patients and their accuracy. We collected data from reports of surgical pathology and ultrasound from breast cancer patients who underwent radiotherapy from 2020 to 2022. We extracted the information using the Generative Pre-trained Transformer (GPT) for Sheets and Docs extension plugin and termed this the "LLM" method. The time and cost of developing the prompts with LLM methods were assessed and compared with those spent on collecting information with "full manual" and "LLM-assisted manual" methods. To assess accuracy, 340 patients were randomly selected, and the extracted information by LLM method were compared with those collected by "full manual" method. Data from 2,931 patients were collected. We developed 12 prompts for Extract function and 12 for Format function to extract and standardize the information. The overall accuracy was 87.7%. For lymphovascular invasion, it was 98.2%. Developing and processing the prompts took 3.5 hours and 15 minutes, respectively. Utilizing the ChatGPT application programming interface cost US $65.8 and when factoring in the estimated wage, the total cost was US $95.4. In an estimated comparison, "LLM-assisted manual" and "LLM" methods were time- and cost-efficient compared to the "full manual" method. Developing and facilitating prompts for LLM to derive clinical factors was efficient to extract crucial information from huge medical records. This study demonstrated the potential of the application of natural language processing using LLM model in breast cancer patients. Prompts from the current study can be re-used for other research to collect clinical information.